No Gardasil, No Papers: Immigrant Women and the HPV Vaccine

By Naima Coster, April 22, 2009

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Op-Ed: A new mandate requiring all female immigrants to receive an expensive new vaccine raises questions.

As of July 2008, female immigrants between the ages of 11 and 26 who seek to adjust their citizenship status are required to receive the vaccine. Gardasil markets itself as part of a sexual health revolution for empowered, educated young women and girls -- from their promotional TV spot, "I Chose," to their website which boasts, "We chose to help protect ourselves…. Now the choice is yours!"

But the message that the vaccine is a way for all young women to protect themselves and make decisions about their own sexual health is partial and false; for immigrant women, the vaccine represents the policing of their bodies.

The mandate is a disturbing marriage between anti-immigrant policy and the capitalist ambitions of pharmaceutical giant, Merck, which produces the vaccine. Merck will be cashing checks every time an immigrant woman or girl seeks citizenship in the United States.

Moreover, enforced vaccination is yet another federal measure to police the bodies of immigrant women. These are women who are already subject to deportation, detention, militaristic border control, raids and other brutal enforcement tactics. Now, sexual health regulations require female immigrants to exchange their freedom to make decisions about their own bodies for American citizenship status.

Unaffordable Alternatives

Priced at nearly $360 for all three doses, it is unlikely that many immigrant women and girls will be able to bear the financial hardship of the vaccine and complete the series. Even in the short-term, the requirement of Gardasil does not sufficiently protect immigrant women and girls from HPV and cervical cancer. In order to be effective, Gardasil must be given as three injections over the course of six months. As the makers of the vaccine advertise, "3 IS KEY." Yet the I-693 "Report of Medical Examination and Vaccination Record" requires that immigrant females receive only the first dose "to be medically cleared for adjustment of status."

For immigrant women and girls with limited access to health care and health education, the potential benefits of Gardasil do not even begin to comprehensively address their sexual health needs. It is important for all women to have regular Pap smears in order to detect cervical cancer. Vaccination does not replace this important test. In this country, women of color and low-income women suffer disproportionately from cervical cancer due to a lack of access to health care and these vital tests. Long after vaccination, immigrant women will experience barriers to quality health care due to their gender, status, class, race and language, which will make these regular screenings a challenge.

The requirement of only one dose, the high cost of the vaccine and the absence of any effort to address larger reproductive and sexual health issues of female immigrants raises the question: What is the benefit of the Gardasil mandate for immigrant women and girls? The U.S. Citizenship and Immigration Services (USCIS) requirement is not a beneficent policy with the health and rights of immigrant women and girls as its core objective. In fact, Gardasil is still a controversial vaccine -- there have been thousands of cases of adverse effects and approximately (PDF) twenty deaths associated with the vaccine. The subjection of an entire generation of immigrant female youth to the vaccine may have alarming public health implications, coinciding as it does with long-standing American anxieties about foreigners and disease, as well as a racist and sexist tradition of using vulnerable female populations of color as test subjects.

Holding the State Accountable

The Gardasil mandate is now being enforced as President Obama launches the Council on Women and Girls, a special White House task force implemented to ensure that federal agencies assess the impact of their policies on women and families. If the new administration is committed to the well-being of women and girls, the Centers for Disease Control (CDC) and USCIS must be held accountable.

These government agencies must consider the cost of the HPV vaccine requirement to immigrant females -- not only in terms of price and potential health risks, but also in terms of reproductive justice and self-determination. Overturning this mandate is urgent if the new administration is committed not only to the issues that affect primarily privileged women, such as "hitting a glass ceiling," but also to the issues that affect those on the margins of society -- poor, queer, minority, young and immigrant women.

The choice that women celebrate on Gardasil's website is a myth so long as some women are not free to decide whether the vaccine is right for them. Vaccines are meant to improve the health of individuals and communities; they should not be tools of a patriarchal and capitalist system that disempower women and profit from the regulation of their bodies. In order to be well, immigrant women need more than a series of injections. Rather, they need a demilitarized immigration system that respects the autonomy of all women and girls to make choices about their bodies -- from their movement across national borders to their reproductive rights.

Naima Coster is a writer and organizer from Brooklyn, New York. She is a graduate of Yale College where she studied English, African American Studies and fiction writing. She works with young people in the South Bronx to raise awareness about immigrant rights through the creative arts.